Periprostatic tissues intraoperative frozen section during retrograde radical retropubic prostatectomy.

OBJECTIVE: To evaluate usefulness of periprostatic tissues intraoperative frozen sections (PTs IFSs) during RRP for prostate cancer, in order to find local extraprostatic neoplastic spreading and to eventually modify intervention and resection limits during surgery. MATERIAL AND METHODS: From January 1998 to June 2004, 259 consecutive patients underwent RRP at our department for clinically organ-confined prostate cancer; PTs IFSs were prospectively performed in all cases at membranous urethra after removal of prostatic apex, at whole neurovascular bundle (NVB) or at fibroadipose tissue subtended between prostatic capsule and NVB during extrafascial or nerve sparing (NS) RRP respectively, at middle portion of Denonvillier's fascia, at detrusor ring after removal of the prostate. IFSs positivity was followed by further excision at the corresponding site during intervention. RRP pathological specimen was handled and examined according to European Association of Urology (EAU) guidelines. Student's t-test and chi-square test were used for statistic analysis, matching patients with or without positive PTs IFSs for bioptic Gleason sum, preoperative serum PSA, clinical stage and lymph nodal involvement. RESULTS: PTs IFSs were positive 75 times in 63 patients out of 259. Pathological stage considering PTs IFSs overlapped 2002 TNM definitive pathological stage in 228 patients. The remaining 31 cases showed PTs neoplastic involvement at IFSs. These latter patients did not show prostatic capsular infiltration at definitive pathology. We demostrated intraoperative extraprostatic cancer spreading that was unrecognizable at definitive pathology. PTs neoplastic spreading changed NS RRP in extrafascial procedure in 17 patients out of 121 with preoperative planned NS RRP There were no significant statistic differences between patients with or without positive periprostatic margins (PMs), regarding preoperative serum PSA, bioptic Gleason sum and clinical stage (Student's t-test); lymph nodal involvement rate was not significantly different in both groups (chi-square test). CONCLUSIONS: PTs IFSs during RRP were feasible and effective in order to achieve better local pathological staging in 12% of patients, to modify planned nerve sparing RRP in extrafascial procedure in 14% of cases and to wide intraoperatively surgical resection margins in 24% of patients.

Color Doppler sonography in the intratesticular varicocele.

OBJECTIVE: We describe and discuss clinical and color Doppler ultrasound findings of intratesticular varicocele. MATERIAL AND METHODS: Since 1998 we evaluated 295 patients diagnosed with varicocele by scrotal color Doppler sonography Routine andrological assessment has entailed grading the varicocele (Dubin-Amelar scale and Dubin Doppler scale) and the assessment of testicular size. Intratesticular varicocele is defined as venous reflux detected into anechoic lesions of the testis with or without ypsilateral varicocele. RESULTS: We detected 4 intratesticular varicoceles (1.3%), in all cases left sided with ypsilateral extratesticular varicocele. Three patients had a large varicocele, one patient had a small varicocele and bylateral testicular hypotrophy. All patients had a slight to severe worsening of sperm quality. CONCLUSIONS: Intratesticular varicocele is an uncommon lesion, first described only after the color Doppler ultrasound studies have been a wide diffusion in the 1990s. A few cases are reported in literature and its incidence is unknown. Data about fertility in males with intratesticular varicocele are still anecdotic. Moreover, the knowledge of intratesticular varicocele may rule out patients for sclerotherapy procedures, or the awarness of potential gonadal damage by aetoxysclerol spread into the testis, may suggest some technical tricks. Since the simple detection of this lesion, further investigations are needed to clarify its clinical and pathophysiological significances. Color Doppler Sonography appears to be the only tool able to identify intratesticular varicocele in order to learn more about this rare condition.

Inflammatory fibrosarcoma of the urachus: a case report.

The Authors reported a case of inflammatory fibrosarcoma of the urachus in a 27-year old woman. Differential diagnosis, surgical therapy and prognosis were discussed.